title: En bloc nephrectomy in patients undergoing post-chemotherapy retroperitoneal lymph node dissection for nonseminomatous testis cancer: indications, implications and outcomes.
abstract: OBJECTIVE
  We review the indications for nephrectomy at post-chemotherapy retroperitoneal lymph node dissection, identify patients at risk for nephrectomy and assess the impact of nephrectomy on outcome.
  
  
  METHODS
  Using a computerized data base and chart review we retrospectively reviewed the records of 848 patients who underwent retroperitoneal lymph node dissection after chemotherapy.
  
  
  RESULTS
  En bloc nephrectomy was performed at retroperitoneal lymph node dissection after chemotherapy in 162 of the 848 patients (19%). The indications for nephrectomy included contiguous involvement of perirenal structures in 73% of the cases, renal vein thrombosis in 6%, a poorly functioning or nonfunctioning renal unit in 5% and a combination of these conditions in 16%. Pathological studies of the hilum revealed cancer in 20% of the cases, teratoma in 49% and fibrosis in 31%. Patients requiring nephrectomy had significantly more advanced disease and larger disease volume at presentation and after chemotherapy. There were no significant differences in perioperative morbidity or mortality compared with patients who did not undergo nephrectomy. Only 3 patients required perioperative dialysis and none required long-term renal support.
  
  
  CONCLUSIONS
  These findings support en bloc nephrectomy at post-chemotherapy retroperitoneal lymph node dissection in select patients with large volume perihilar retroperitoneal disease.
authors.affiliation: Department of Urology, Indiana University Medical Center, Indianapolis, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Nash
authors.forename: I
authors.initials: I
authors.lastname: Leibovitch
authors.forename: R S
authors.initials: RS
authors.lastname: Foster
authors.forename: R
authors.initials: R
authors.lastname: Bihrle
authors.forename: R G
authors.initials: RG
authors.lastname: Rowland
authors.forename: J P
authors.initials: JP
authors.lastname: Donohue
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D006801:Humans; D007680:Kidney Neoplasms / Q000556:secondary* / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D009392:Nephrectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D017211:Treatment Failure
chemical_list: D003404:Creatinine